- Email: [email protected]
Reviews of Books
447 TABLE IV-PREVALENCE OF VARIOUS HABITS IN TWINS WHO WALK IN THEIR SLEEP
frequency of nail-biting. significant statistically.
The differences
are
not
Discussion
widely accepted view that sleepContrary is the walking acting out of a dream, sleep-walking occur episodes during non-dream or non-rapid-eyemovement (N.R.E.M.) sleep-typically stages 3 and 4.*’’* They begin characteristically with a paroxysmal burst of high voltage, slow E.E.G. activity. Similar E.E.G. changes are seen during sleep stages 3 and 4 in some young children who are not sleep-walkers, but the changes are less frequent and briefer. They are not seen in normal children after 9 years.6 On the basis of the E.E.G. changes and on the clinical observation that children outgrow the habit, Kales and Jacobson5 concluded that sleep-walking is a manifestation of immaturity which corrects itself to
the
Reviews of Books
as maturation proceeds. As further evidence against the view that sleep-walking is a neurotic manifestation, they point out that disappearance of the symptom does not lead to replacement by a substitute or equivalent symptom. The studies in twins and the data on family prevalence suggest that sleep-walking has a genetic basis. Monozygotic twins were concordant for the symptom six times as frequently as dizygotic twins. In general, the closer the genetic relationship, the greater the likelihood of the symptom being transmitted. Thus, when a parent gave a history of sleep-walking the chances of a child also being a sleep-walker were almost six times as great as when neither parent had
sleep-walked. I am indebted to Dr. Julian B. Schorr, chief of blood bank services of the Albert Einstein College of Medicine-Bronx Municipal Hospital Center, in whose laboratories the bloodtypings were carried out. I also wish to acknowledge the assistance of members of the Twins’ Mothers Clubs, the Suburban Mothers of Twins and Triplets Clubs, and the Mothers of Twins Clubs. REFERENCES
Jacobson, A., Henn, R. M., Kales, A. Unpublished. Davis, E., Hayes, M., Kirman, B. H. Lancet, 1942, i, 186. Pierce, C. M., Lipcon, H. H. A.M.A. Archs Neurol. Psychiat. 1956, 76, 3. 4. Gastaut, H., Broughton, R. Recent Adv. Biol. Psychiat. 1965, 7, 197. 5. Kales, A., Jacobson, A. Proceedings of the Fifteenth European Meeting on Electroencephalography. Bologna, 1967. 6. Gibbs, F. A., Gibbs, E. L. Atlas of Electroencephalography; vol. I. Cambridge, Mass., 1950. 1. 2. 3.
offered-a ensure
Welfare Medical Care: an Experiment CHARLES H. GOODRICH, M.D., associate professor of
com-
medicine and director of the division of health care, Mount Sinai School of Medicine; MARGARET C. OLENDZKI, M.D., assistant professor of medicine, Mount Sinai School of Medicine; and GEORGE G. READER, M.D., professor of medicine, Cornell University Medical College. Cambridge, Harvard University Press. Massachusetts: London: Cambridge University Press. 1970. Pp. 343.$7; 66s.
munity
THE medical-care revolution in the United States is momentum, and among the forces pressing it forward are popular reaction against the position taken by the American Medical Association and the clear thinking of a number of health agencies and universities. In the late 1950s the City of New York and Cornell University were planning a case-controlled prospective study of the costs and benefits of an integrated system of medical care. Among those who suffer from unintegrated care in the U.S.A. are the " welfare " patients of the great cities, and these, perhaps because they are in no position to argue, have often been subjected to experiment. However, they have benefited from almost all of these experiments, especially the one described in this book. Participants were selected at random from welfare patients in New York City. One group was offered medical care of all kinds by the New York Hospital: the controls were left untouched to forage among the piecemeal services then available in the district of New York. The two groups were watched systematically for two years. Equality of need and background was ensured by the random selection, and evaluation of the two systems of care was based upon the patients’ use of services, the cost of care (relatively easy to measure in U.S.A.), and various measures of quality including an estimate of patient satisfaction. The efficacy of care (in the sense of achievement of medical objectives) was not measured. Integration was assured by three features of the experimental care
gathering
single site for all care, a personal physician to continuity, and special efforts to achieve good
communications between members of the team. The results of this survey are less important than the inspiration behind it and the methods which were used. But, on the whole, the results support the notion that integrated care is better than unintegrated care, though it may not be cheaper. In Britain, where total populations can be sampled and subtler indices used than in the U.S.A., this study model would have more chance of success. Moves towards an integration of health and welfare services in Britain would certainly benefit from much closer scrutiny of detail. This New York project, an imaginative venture carried through in very taxing circumstances, shows us at least one of the models to use.
Penicillin Allergy
by GORDON T. STEwART, M.D., Watkins professor and chairman, department of epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; and JOHN P. McGOVERN, M.D., clinical professor of pediatrics (allergy) and microbiology, Baylor College of Medicine, clinical professor of allergy, University of Texas School of Biomedical Sciences, and director, McGovern Allergy Clinic, Houston, Texas. Springfield, Illinois: Charles C. Thomas. 1970. Pp. 196.$10.50. Now that more and more attention is being given to adverse reactions to drugs, a book on penicillin allergy is Edited
timely: the penicillin group of antibiotics is probably responsible for more than 70°o of all drug reactions, and is almost certainly the leading cause of mortality attributable to allergy. Fifteen authors present in the eleven chapters of this small volume an account of most present-day knowledge of penicillin allergy. The book is mainly concerned with research aspects of the immunology of penicillin allergy, and there are five excellent chapters on the immunochemistry of penicillin, serum antibodies to red-blood-cell conjugates, and immediate skin reactions in penicillin allergy, and experimental work on the mechanism of penicillin allergenicity with reference to the major and
448 minor derivatives of the penicillin molecule and also to proteinaceous contaminants and to macromolecular components of preparations of &bgr;-lactam antibiotics. The inclusion in other chapters of some clinical studies increases the value of the book and widens its area of appeal to include clinicians as well as immunologists. Clinicians will find the chapter on antibiotic therapy in patients with a history of penicillin allergy very useful. A scheme for the cautious administration to such patients of increasing doses of penicillin in those life-threatening situations where penicillin is the antibiotic of choice and other drugs are inadequate is given in detail. Using this scheme, together with steroids and antihistamines if necessary, it is possible to complete penicillin therapy in the great majority of such patients. The book is clearly written throughout so that what are in certain areas extremely complex situations become, in the main, clearly understandable. The last chapter is an extremely good summary of the problem of penicillin allergy. What of the book’s faults ? The chapter on incidence and manifestations of penicillin allergy should have included a fuller description of the types of reactions to penicillin than is afforded in less than a page. Nowhere in the book are the differences in reactions to the different types of penicillin discussed. Instead there is the traditional (and convenient) assumption that there is cross-allergenicity to all forms of penicillin. But surely there is now sufficient clinical evidence to indicate that many reactions to ampicillin, for example, are not " true penicillin " allergies ? In chapter 8, on penicilloyl-polylysine skin testing in a venereal-disease clinic, the results presented neither support nor refute the conclusion that skin-test results and the subsequent avoidance of penicillin in positive reactors were responsible for the reduction in penicillinreaction rates over the period of study. Many will disagree with the statements in chapter 10 that vancomycin is the only reasonable alternative to penicillins in serious staphylococcal infections and that chloramphenicol is the only reasonable alternative in pneumococcal meningitis. But these are minor criticisms, and this well-referenced book is to be highly recommended to all physicians interested in
penicillin allergy. An introduction to the
Biology
of the Skin
R. H. CHAMPION, consultant dermatologist, Addenbrooke’s Hospital, Cambridge; T. GILLMAN, head, department of experimental pathology, A.R.C. Institute of Animal Physiology, Babraham; A. J. RooK, consultant dermatologist, Addenbrooke’s Hospital, Cambridge; and R. T. SiMS, department of anatomy, University of Cambridge. Oxford: Blackwell Scientific Publications. 1970. Pp. 450. 85s. SINCE 1963 Dr. Rook has organised an annual course of
lecturesat Cambridge in which dermatologists in training presented with up-to-date knowledge of the biology and pathology of the skin. The course draws an international audience and is regularly oversubscribed. This book is an outcome of this experience. It was written by twelve authors besides the four editors who themselves contribute 12 of the 27 chapters. 18 are concerned with the morphology and function of the skin, and there are others are
inflammation, immunological mechanisms, microorganisms, and nutrition. There are interesting accounts of racial and regional variations in the behaviour of the skin and of comparative biological features. Most of the chapters on
brief and clear, but the balance is lost in three unnecessarily long and complex chapters written by Dr. Gillman. The bibliography is international and helpful. There might have been a happier policy on illustrations, one of which shows a rat being shampooed in the interests of science. The authors and publishers are to be congratulated on supplying a book for which there is a genuine, if limited, need and no obvious substitute. are
The Mechanism and Management of Headache JAMES W. LANCE, M.D., M.R.C.P., F.R.A.C.P., chairman, division of neurology, Prince Henry Hospital, Little Bay, Sydney; associate professor of medicine, University of New South Wales, Sydney. London:Butterworths. 1970. Pp. 167. 45s.
HEADACHE is one of the commonest of all symptoms. Its medical implications can range from the trivial to the disastrous. The problem is to recognise the serious early and to avoid unnecessary and untimely investigation of the trivial. This small book will help neurologists, general physicians, and practitioners to do both these. It can also be recommended to students as a sensible coverage of an important aspect of clinical work. It has excellent and upto-date references for those interested in further reading.
Autoimmunization and the Autoimmune
Anemias
Hemolytic
BERNARD PIROFSKY, M.D., professor of medicine, and head, division of immunology, allergy and infectious disease, University of Oregon Medical School, Portland, Oregon. Wilkins. Edinburgh: E. & Baltimore: Williams & S. Livingstone. 1969. Pp. 537.$19.50; E9.
THE hsemolytic anxmias provide some of the plainest examples of autoimmune disease, but at the same time some perplexing problems of how it arises. A lack of rapport between haematologists and immunologists sometimes threatens to develop, and Dr. Pirofsky’s aim is to foster better mutual understanding of the autoimmune haemolytic anaemias by considering clinical, serological,
aaiological, and theoretical aspects all under one cover. The book he has produced still falls into two very separate halves. The first is based on the information obtained from study of 284 patients with acquired haemolytic anaemia seen during an eight-year period in Dr. Pirofsky’s department, and the second deals with serological aspects, and with the problems of aetiology which are discussed critically. Careful assessment and well-argued classification of the cases he and his colleagues have investigated have led Dr. Pirofsky to the conclusion that, in most cases, autoimmune haemolytic anaemia is a part (sometimes the only diagnosable part) of a more complex systemic aberration, most likely centred on immune deficiency in one form or another-a paradox that now many immunological researchworkers will be inclined to support. This volume does not seriously challenge the exceptional position of Part 2 of J. V. Dacie’s Hœmolytic Ancemias, but it provides an up-to-date review based on personal experience that immunologists, haematologists, and many less specialised practitioners will be grateful for. An Introduction to Neurosurgery (2nd ed. London: William Heinemann Medical Books. 1970. Pp. 363. 70s.).This expanded edition of Prof. W. Bryan Jennett’s text shows the same clarity that distinguishes all its author’s writings. He has an orderly mind, and a gift for presenting material to the beginner without vagueness or redundancy. The didactic method serves well with established principles and practices, and the book should be very popular with students, who may reasonably be expected to know its contents. Recent advances are treated briefly because less is known with certainty. New Editions An Introduction to Functional Anatomy.-4th ed. By David Sinclair. Oxford: Blackwell Scientific Publications. 1970. Pp. 542. 75s.
Current Medical Treatment.-3rd ed. Edited by C. W. H. Havard. London: Staples Press. 1970. Pp. 882. 85s. Medical Disorders in Obstetric Practice.-3rd ed. By Cyril G. Barnes. Oxford: Blackwell Scientific Publications. 1970. Pp. 482. 80s.
frequency of nail-biting. significant statistically.
The differences
are
not
Discussion
widely accepted view that sleepContrary is the walking acting out of a dream, sleep-walking occur episodes during non-dream or non-rapid-eyemovement (N.R.E.M.) sleep-typically stages 3 and 4.*’’* They begin characteristically with a paroxysmal burst of high voltage, slow E.E.G. activity. Similar E.E.G. changes are seen during sleep stages 3 and 4 in some young children who are not sleep-walkers, but the changes are less frequent and briefer. They are not seen in normal children after 9 years.6 On the basis of the E.E.G. changes and on the clinical observation that children outgrow the habit, Kales and Jacobson5 concluded that sleep-walking is a manifestation of immaturity which corrects itself to
the
Reviews of Books
as maturation proceeds. As further evidence against the view that sleep-walking is a neurotic manifestation, they point out that disappearance of the symptom does not lead to replacement by a substitute or equivalent symptom. The studies in twins and the data on family prevalence suggest that sleep-walking has a genetic basis. Monozygotic twins were concordant for the symptom six times as frequently as dizygotic twins. In general, the closer the genetic relationship, the greater the likelihood of the symptom being transmitted. Thus, when a parent gave a history of sleep-walking the chances of a child also being a sleep-walker were almost six times as great as when neither parent had
sleep-walked. I am indebted to Dr. Julian B. Schorr, chief of blood bank services of the Albert Einstein College of Medicine-Bronx Municipal Hospital Center, in whose laboratories the bloodtypings were carried out. I also wish to acknowledge the assistance of members of the Twins’ Mothers Clubs, the Suburban Mothers of Twins and Triplets Clubs, and the Mothers of Twins Clubs. REFERENCES
Jacobson, A., Henn, R. M., Kales, A. Unpublished. Davis, E., Hayes, M., Kirman, B. H. Lancet, 1942, i, 186. Pierce, C. M., Lipcon, H. H. A.M.A. Archs Neurol. Psychiat. 1956, 76, 3. 4. Gastaut, H., Broughton, R. Recent Adv. Biol. Psychiat. 1965, 7, 197. 5. Kales, A., Jacobson, A. Proceedings of the Fifteenth European Meeting on Electroencephalography. Bologna, 1967. 6. Gibbs, F. A., Gibbs, E. L. Atlas of Electroencephalography; vol. I. Cambridge, Mass., 1950. 1. 2. 3.
offered-a ensure
Welfare Medical Care: an Experiment CHARLES H. GOODRICH, M.D., associate professor of
com-
medicine and director of the division of health care, Mount Sinai School of Medicine; MARGARET C. OLENDZKI, M.D., assistant professor of medicine, Mount Sinai School of Medicine; and GEORGE G. READER, M.D., professor of medicine, Cornell University Medical College. Cambridge, Harvard University Press. Massachusetts: London: Cambridge University Press. 1970. Pp. 343.$7; 66s.
munity
THE medical-care revolution in the United States is momentum, and among the forces pressing it forward are popular reaction against the position taken by the American Medical Association and the clear thinking of a number of health agencies and universities. In the late 1950s the City of New York and Cornell University were planning a case-controlled prospective study of the costs and benefits of an integrated system of medical care. Among those who suffer from unintegrated care in the U.S.A. are the " welfare " patients of the great cities, and these, perhaps because they are in no position to argue, have often been subjected to experiment. However, they have benefited from almost all of these experiments, especially the one described in this book. Participants were selected at random from welfare patients in New York City. One group was offered medical care of all kinds by the New York Hospital: the controls were left untouched to forage among the piecemeal services then available in the district of New York. The two groups were watched systematically for two years. Equality of need and background was ensured by the random selection, and evaluation of the two systems of care was based upon the patients’ use of services, the cost of care (relatively easy to measure in U.S.A.), and various measures of quality including an estimate of patient satisfaction. The efficacy of care (in the sense of achievement of medical objectives) was not measured. Integration was assured by three features of the experimental care
gathering
single site for all care, a personal physician to continuity, and special efforts to achieve good
communications between members of the team. The results of this survey are less important than the inspiration behind it and the methods which were used. But, on the whole, the results support the notion that integrated care is better than unintegrated care, though it may not be cheaper. In Britain, where total populations can be sampled and subtler indices used than in the U.S.A., this study model would have more chance of success. Moves towards an integration of health and welfare services in Britain would certainly benefit from much closer scrutiny of detail. This New York project, an imaginative venture carried through in very taxing circumstances, shows us at least one of the models to use.
Penicillin Allergy
by GORDON T. STEwART, M.D., Watkins professor and chairman, department of epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; and JOHN P. McGOVERN, M.D., clinical professor of pediatrics (allergy) and microbiology, Baylor College of Medicine, clinical professor of allergy, University of Texas School of Biomedical Sciences, and director, McGovern Allergy Clinic, Houston, Texas. Springfield, Illinois: Charles C. Thomas. 1970. Pp. 196.$10.50. Now that more and more attention is being given to adverse reactions to drugs, a book on penicillin allergy is Edited
timely: the penicillin group of antibiotics is probably responsible for more than 70°o of all drug reactions, and is almost certainly the leading cause of mortality attributable to allergy. Fifteen authors present in the eleven chapters of this small volume an account of most present-day knowledge of penicillin allergy. The book is mainly concerned with research aspects of the immunology of penicillin allergy, and there are five excellent chapters on the immunochemistry of penicillin, serum antibodies to red-blood-cell conjugates, and immediate skin reactions in penicillin allergy, and experimental work on the mechanism of penicillin allergenicity with reference to the major and
448 minor derivatives of the penicillin molecule and also to proteinaceous contaminants and to macromolecular components of preparations of &bgr;-lactam antibiotics. The inclusion in other chapters of some clinical studies increases the value of the book and widens its area of appeal to include clinicians as well as immunologists. Clinicians will find the chapter on antibiotic therapy in patients with a history of penicillin allergy very useful. A scheme for the cautious administration to such patients of increasing doses of penicillin in those life-threatening situations where penicillin is the antibiotic of choice and other drugs are inadequate is given in detail. Using this scheme, together with steroids and antihistamines if necessary, it is possible to complete penicillin therapy in the great majority of such patients. The book is clearly written throughout so that what are in certain areas extremely complex situations become, in the main, clearly understandable. The last chapter is an extremely good summary of the problem of penicillin allergy. What of the book’s faults ? The chapter on incidence and manifestations of penicillin allergy should have included a fuller description of the types of reactions to penicillin than is afforded in less than a page. Nowhere in the book are the differences in reactions to the different types of penicillin discussed. Instead there is the traditional (and convenient) assumption that there is cross-allergenicity to all forms of penicillin. But surely there is now sufficient clinical evidence to indicate that many reactions to ampicillin, for example, are not " true penicillin " allergies ? In chapter 8, on penicilloyl-polylysine skin testing in a venereal-disease clinic, the results presented neither support nor refute the conclusion that skin-test results and the subsequent avoidance of penicillin in positive reactors were responsible for the reduction in penicillinreaction rates over the period of study. Many will disagree with the statements in chapter 10 that vancomycin is the only reasonable alternative to penicillins in serious staphylococcal infections and that chloramphenicol is the only reasonable alternative in pneumococcal meningitis. But these are minor criticisms, and this well-referenced book is to be highly recommended to all physicians interested in
penicillin allergy. An introduction to the
Biology
of the Skin
R. H. CHAMPION, consultant dermatologist, Addenbrooke’s Hospital, Cambridge; T. GILLMAN, head, department of experimental pathology, A.R.C. Institute of Animal Physiology, Babraham; A. J. RooK, consultant dermatologist, Addenbrooke’s Hospital, Cambridge; and R. T. SiMS, department of anatomy, University of Cambridge. Oxford: Blackwell Scientific Publications. 1970. Pp. 450. 85s. SINCE 1963 Dr. Rook has organised an annual course of
lecturesat Cambridge in which dermatologists in training presented with up-to-date knowledge of the biology and pathology of the skin. The course draws an international audience and is regularly oversubscribed. This book is an outcome of this experience. It was written by twelve authors besides the four editors who themselves contribute 12 of the 27 chapters. 18 are concerned with the morphology and function of the skin, and there are others are
inflammation, immunological mechanisms, microorganisms, and nutrition. There are interesting accounts of racial and regional variations in the behaviour of the skin and of comparative biological features. Most of the chapters on
brief and clear, but the balance is lost in three unnecessarily long and complex chapters written by Dr. Gillman. The bibliography is international and helpful. There might have been a happier policy on illustrations, one of which shows a rat being shampooed in the interests of science. The authors and publishers are to be congratulated on supplying a book for which there is a genuine, if limited, need and no obvious substitute. are
The Mechanism and Management of Headache JAMES W. LANCE, M.D., M.R.C.P., F.R.A.C.P., chairman, division of neurology, Prince Henry Hospital, Little Bay, Sydney; associate professor of medicine, University of New South Wales, Sydney. London:Butterworths. 1970. Pp. 167. 45s.
HEADACHE is one of the commonest of all symptoms. Its medical implications can range from the trivial to the disastrous. The problem is to recognise the serious early and to avoid unnecessary and untimely investigation of the trivial. This small book will help neurologists, general physicians, and practitioners to do both these. It can also be recommended to students as a sensible coverage of an important aspect of clinical work. It has excellent and upto-date references for those interested in further reading.
Autoimmunization and the Autoimmune
Anemias
Hemolytic
BERNARD PIROFSKY, M.D., professor of medicine, and head, division of immunology, allergy and infectious disease, University of Oregon Medical School, Portland, Oregon. Wilkins. Edinburgh: E. & Baltimore: Williams & S. Livingstone. 1969. Pp. 537.$19.50; E9.
THE hsemolytic anxmias provide some of the plainest examples of autoimmune disease, but at the same time some perplexing problems of how it arises. A lack of rapport between haematologists and immunologists sometimes threatens to develop, and Dr. Pirofsky’s aim is to foster better mutual understanding of the autoimmune haemolytic anaemias by considering clinical, serological,
aaiological, and theoretical aspects all under one cover. The book he has produced still falls into two very separate halves. The first is based on the information obtained from study of 284 patients with acquired haemolytic anaemia seen during an eight-year period in Dr. Pirofsky’s department, and the second deals with serological aspects, and with the problems of aetiology which are discussed critically. Careful assessment and well-argued classification of the cases he and his colleagues have investigated have led Dr. Pirofsky to the conclusion that, in most cases, autoimmune haemolytic anaemia is a part (sometimes the only diagnosable part) of a more complex systemic aberration, most likely centred on immune deficiency in one form or another-a paradox that now many immunological researchworkers will be inclined to support. This volume does not seriously challenge the exceptional position of Part 2 of J. V. Dacie’s Hœmolytic Ancemias, but it provides an up-to-date review based on personal experience that immunologists, haematologists, and many less specialised practitioners will be grateful for. An Introduction to Neurosurgery (2nd ed. London: William Heinemann Medical Books. 1970. Pp. 363. 70s.).This expanded edition of Prof. W. Bryan Jennett’s text shows the same clarity that distinguishes all its author’s writings. He has an orderly mind, and a gift for presenting material to the beginner without vagueness or redundancy. The didactic method serves well with established principles and practices, and the book should be very popular with students, who may reasonably be expected to know its contents. Recent advances are treated briefly because less is known with certainty. New Editions An Introduction to Functional Anatomy.-4th ed. By David Sinclair. Oxford: Blackwell Scientific Publications. 1970. Pp. 542. 75s.
Current Medical Treatment.-3rd ed. Edited by C. W. H. Havard. London: Staples Press. 1970. Pp. 882. 85s. Medical Disorders in Obstetric Practice.-3rd ed. By Cyril G. Barnes. Oxford: Blackwell Scientific Publications. 1970. Pp. 482. 80s.